{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T04:13:01Z","timestamp":1783656781147,"version":"3.55.0"},"reference-count":101,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["aspenjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Parenter Enteral Nutr"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>When critical illness is further complicated by severe respiratory failure, such as in cases of acute respiratory distress syndrome (ARDS) requiring veno\u2010venous extracorporeal membrane oxygenation (VV\u2010ECMO), patients may be at an even greater risk for nutritional deficits, immobility, and persistent metabolic stress. Although highly efficacious for cardiopulmonary failure, VV\u2010ECMO introduces the potential for additional metabolic complexities, including altered thermoregulation, increased inflammatory burden, and, traditionally, impaired physical activity from increased lengths of intensive care unit (ICU) stays and prolonged periods of bedrest. Emerging data suggest that comprehensive metabolic and rehabilitative strategies can attenuate muscle loss, reduce ICU\u2010acquired weakness, and improve post\u2010discharge outcomes. This narrative review will discuss the metabolic demands faced by VV\u2010ECMO patients and current strategies to address them. We characterize the catabolic state during VV\u2010ECMO while highlighting the metabolic demand placed on patients. We then examine nutritional support on VV\u2010ECMO, including the assessment of energy expenditure and its limitations, optimal calorie\u2010protein requirements, timing and route of nutritional support, and outcomes associated with nutritional adequacy based on current evidence and guidelines. Next, we explore the potential of pharmacologic agents to possibly reduce hypermetabolism and reverse catabolism. Finally, we discuss the role of physical rehabilitation in VV\u2010ECMO patients by focusing on physical therapy, mobilization, and strategies such as awake ECMO to facilitate activity. Throughout this review, we integrate findings from recent studies and guidelines, with the goal of providing a comprehensive narrative of how to support the metabolic needs of critically ill patients on VV\u2010ECMO.<\/jats:p>","DOI":"10.1002\/jpen.70088","type":"journal-article","created":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T15:53:09Z","timestamp":1775058789000},"page":"625-634","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Addressing metabolic demands during veno\u2010venous extracorporeal life support: A narrative review"],"prefix":"10.1002","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9489-3633","authenticated-orcid":false,"given":"Daniel T.","family":"Lammers","sequence":"first","affiliation":[{"name":"University of North Carolina at Chapel Hill Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-5211-0191","authenticated-orcid":false,"given":"Perry","family":"Wiseman","sequence":"additional","affiliation":[{"name":"Womack Army Medical Center Fayetteville North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nafis","family":"Deen","sequence":"additional","affiliation":[{"name":"Methodist Healthcare System of San Antonio San Antonio Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarita","family":"Thanedar","sequence":"additional","affiliation":[{"name":"Methodist Healthcare System of San Antonio San Antonio Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nawsin","family":"Baset","sequence":"additional","affiliation":[{"name":"Methodist Healthcare System of San Antonio San Antonio Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5916-7345","authenticated-orcid":false,"given":"Gongkai","family":"Liu","sequence":"additional","affiliation":[{"name":"Methodist Healthcare System of San Antonio San Antonio Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey D.","family":"DellaVolpe","sequence":"additional","affiliation":[{"name":"Methodist Healthcare System of San Antonio San Antonio Texas USA"},{"name":"Institute for Extracorporeal Life Support San Antonio Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-7084-8576","authenticated-orcid":false,"given":"Linda E.","family":"Sousse","sequence":"additional","affiliation":[{"name":"University of North Carolina at Chapel Hill Chapel Hill North Carolina USA"},{"name":"Institute for Extracorporeal Life Support San Antonio Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,1]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-022-04253-0"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/jcsm.12620"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1800385"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.14276"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)61069-2"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-016-1570-4"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/jpen.2467"},{"issue":"6","key":"e_1_2_11_9_1","first-page":"2346","article-title":"Nutritional implications for the patient undergoing extracorporeal membrane oxygenation","volume":"31","author":"Far\u00edas MM","year":"2015","journal-title":"Nutr Hosp"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-004-2384-4"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aeu187"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.278481"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph21070908"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000004827"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrtlng.2020.12.014"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2018.08.002"},{"key":"e_1_2_11_17_1","unstructured":"ELSO Guidelines for Patient Care Respiratory and Cardiac Support ECMO in COVID\u201019 [Internet]. [cited 2025 Aug 17]. Available from:https:\/\/www.elso.org\/ecmo-resources\/elso-ecmo-guidelines.aspx"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clnu.2021.03.015"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/jpen.1176"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.3389\/fnut.2022.961207"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12871-021-01439-x"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu10010010"},{"issue":"5","key":"e_1_2_11_23_1","first-page":"253","article-title":"Use of nutrition risk in critically ill (NUTRIC) score to assess nutritional risk in mechanically ventilated patients: a prospective observational study","volume":"21","author":"Kalaiselvan MS","year":"2017","journal-title":"Ind J Crit Care Med"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clnu.2018.01.012"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu15092098"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-019-2657-5"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/aas.13287"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clnu.2017.01.001"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1097\/MCC.0000000000000844"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-023-04539-x"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1177\/0148607115621863"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41430-023-01319-2"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1177\/014860710302700121"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.1111\/aas.12564"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41430-023-01291-x"},{"key":"e_1_2_11_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clnu.2018.08.037"},{"key":"e_1_2_11_37_1","doi-asserted-by":"publisher","DOI":"10.1002\/jpen.2364"},{"key":"e_1_2_11_38_1","doi-asserted-by":"publisher","DOI":"10.1097\/MAT.0000000000001193"},{"key":"e_1_2_11_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clnu.2023.07.011"},{"key":"e_1_2_11_40_1","doi-asserted-by":"publisher","DOI":"10.1002\/jpen.2267"},{"key":"e_1_2_11_41_1","doi-asserted-by":"publisher","DOI":"10.1186\/cc2190"},{"key":"e_1_2_11_42_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-006-0128-3"},{"key":"e_1_2_11_43_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41430-021-00860-2"},{"issue":"8","key":"e_1_2_11_44_1","article-title":"Post\u2010pyloric versus gastric tube feeding for preventing pneumonia and improving nutritional outcomes in critically ill adults","volume":"15","author":"Alkhawaja S","year":"2015","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_11_45_1","doi-asserted-by":"publisher","DOI":"10.1002\/ncp.10591"},{"key":"e_1_2_11_46_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clnu.2023.07.021"},{"key":"e_1_2_11_47_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-013-3053-2"},{"key":"e_1_2_11_48_1","doi-asserted-by":"publisher","DOI":"10.1177\/0148607104028005295"},{"key":"e_1_2_11_49_1","doi-asserted-by":"publisher","DOI":"10.1097\/00024382-199809000-00001"},{"key":"e_1_2_11_50_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2011.12.038"},{"key":"e_1_2_11_51_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.sla.0000137131.22608.e2"},{"key":"e_1_2_11_52_1","doi-asserted-by":"publisher","DOI":"10.1002\/ncp.10468"},{"key":"e_1_2_11_53_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mehy.2020.110287"},{"key":"e_1_2_11_54_1","doi-asserted-by":"publisher","DOI":"10.1155\/2018\/4545623"},{"key":"e_1_2_11_55_1","doi-asserted-by":"publisher","DOI":"10.4266\/acc.2021.01767"},{"key":"e_1_2_11_56_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.beem.2011.06.002"},{"key":"e_1_2_11_57_1","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2020.569633"},{"key":"e_1_2_11_58_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-199212000-00006"},{"key":"e_1_2_11_59_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-199504000-00014"},{"key":"e_1_2_11_60_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-199603000-00008"},{"key":"e_1_2_11_61_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9610(96)00033-5"},{"key":"e_1_2_11_62_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e3181b8f9ca"},{"key":"e_1_2_11_63_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199909093411102"},{"key":"e_1_2_11_64_1","doi-asserted-by":"publisher","DOI":"10.1097\/00008480-199508000-00020"},{"key":"e_1_2_11_65_1","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2013.00064"},{"key":"e_1_2_11_66_1","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-11-0778"},{"key":"e_1_2_11_67_1","doi-asserted-by":"publisher","DOI":"10.4266\/kjccm.2016.00024"},{"key":"e_1_2_11_68_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tem.2004.10.007"},{"key":"e_1_2_11_69_1","doi-asserted-by":"publisher","DOI":"10.1038\/35051587"},{"key":"e_1_2_11_70_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.physbeh.2011.04.013"},{"key":"e_1_2_11_71_1","doi-asserted-by":"publisher","DOI":"10.1507\/endocrj.K09E-168"},{"key":"e_1_2_11_72_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1369-1600.2006.00002.x"},{"key":"e_1_2_11_73_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1369-1600.2006.00041.x"},{"key":"e_1_2_11_74_1","doi-asserted-by":"publisher","DOI":"10.2174\/157015909787602779"},{"key":"e_1_2_11_75_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pscychresns.2014.04.015"},{"key":"e_1_2_11_76_1","doi-asserted-by":"publisher","DOI":"10.1038\/45230"},{"key":"e_1_2_11_77_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cyto.2012.08.031"},{"key":"e_1_2_11_78_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ghir.2007.11.005"},{"key":"e_1_2_11_79_1","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.1990.01410150114021"},{"key":"e_1_2_11_80_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2012-4247"},{"key":"e_1_2_11_81_1","doi-asserted-by":"publisher","DOI":"10.1155\/2014\/215858"},{"key":"e_1_2_11_82_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-019-05593-2"},{"key":"e_1_2_11_83_1","doi-asserted-by":"publisher","DOI":"10.3389\/fnut.2025.1505797"},{"key":"e_1_2_11_84_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu11092082"},{"key":"e_1_2_11_85_1","doi-asserted-by":"publisher","DOI":"10.1080\/07315724.2018.1451789"},{"key":"e_1_2_11_86_1","doi-asserted-by":"publisher","DOI":"10.1002\/jcsm.12952"},{"key":"e_1_2_11_87_1","doi-asserted-by":"publisher","DOI":"10.1177\/014860710402800265"},{"key":"e_1_2_11_88_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-016-4249-z"},{"key":"e_1_2_11_89_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.278477"},{"key":"e_1_2_11_90_1","doi-asserted-by":"publisher","DOI":"10.1080\/07853890.2022.2098376"},{"key":"e_1_2_11_91_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2019.06.024"},{"key":"e_1_2_11_92_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.jvca.2011.05.013"},{"key":"e_1_2_11_93_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-023-04648-7"},{"key":"e_1_2_11_94_1","doi-asserted-by":"publisher","DOI":"10.1097\/MAT.0000000000002375"},{"key":"e_1_2_11_95_1","doi-asserted-by":"publisher","DOI":"10.5935\/0103-507X.20190017"},{"key":"e_1_2_11_96_1","doi-asserted-by":"publisher","DOI":"10.1097\/MAT.0000000000000239"},{"key":"e_1_2_11_97_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000002770"},{"key":"e_1_2_11_98_1","doi-asserted-by":"publisher","DOI":"10.3390\/nursrep13020066"},{"key":"e_1_2_11_99_1","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.202102-151OC"},{"key":"e_1_2_11_100_1","doi-asserted-by":"publisher","DOI":"10.1051\/ject\/2024023"},{"key":"e_1_2_11_101_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrtlng.2023.05.022"},{"key":"e_1_2_11_102_1","doi-asserted-by":"publisher","DOI":"10.1186\/cc13746"}],"container-title":["Journal of Parenteral and Enteral Nutrition"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/aspenjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jpen.70088","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aspenjournals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jpen.70088","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aspenjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jpen.70088","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T03:16:32Z","timestamp":1783653392000},"score":1,"resource":{"primary":{"URL":"https:\/\/aspenjournals.onlinelibrary.wiley.com\/doi\/10.1002\/jpen.70088"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,1]]},"references-count":101,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1002\/jpen.70088"],"URL":"https:\/\/doi.org\/10.1002\/jpen.70088","archive":["Portico"],"relation":{},"ISSN":["0148-6071","1941-2444"],"issn-type":[{"value":"0148-6071","type":"print"},{"value":"1941-2444","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,1]]},"assertion":[{"value":"2025-08-26","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-12","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-01","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}